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General NPI Number Information
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NPI Number | 1285926501
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Entity Type | Organization
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Legal Business Name | LADD MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 01/10/2020
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Provider Practice Location Address
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Address Line | 2600 65TH AVENUE
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City | OSCEOLA
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State | WI
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Zip | 54020-0218
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Country | US
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Telephone | 715-294-4050
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Fax | 715-294-5690
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Provider Business Mailing Address
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Address Line | PO BOX 218
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City | OSCEOLA
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State | WI
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Zip | 54020-0218
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Country | US
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Telephone | 715-294-4050
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Fax | 715-294-5690
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MATT FORGE
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Credential |
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Telephone | 715-294-5622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 9071-042
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License Number State | WI
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